Abstract
The field of Cardio-oncology is rapidly growing with significant advances in research leading to better understanding of the underlying pathogenesis with implications in the diagnosis and management of cancer-related cardiomyopathy. Parallel to advancement in cardio-oncology is an increased awareness of the incidence of congestive heart failure and cardiomyopathy associated with malignancy. While specific cardiotoxic profiles exist for certain chemotherapeutic agents, there is increasing evidence of unexpected cardiotoxic side effects of some therapeutic modalities, combination chemo- and radiotherapy with large analyses identifying a strong association between malignancy and Takotsubo cardiomyopathy. Takotsubo Cardiomyopathy, also known as "broken-heart" syndrome or stress cardiomyopathy, is characterized by transient and reversible, regional or global, myocardial dysfunction without inciting ischemic perfusion defect from obstructive coronary artery disease. While direct causative pathophysiologic mechanisms continue to be investigated, much of the postulated pathways center on the high emotional and physical burdens of cancer and the related emotional stress associated with the diagnosis of cancer as well as the corporal effects of anti-neoplastic therapies, radiation, and oncologic surgery. In this manuscript we review the most current data in this rapidly emerging field highlighting the epidemiology, the postulated pathogenetic mechanisms as well as the current guidelines by major societies addressing malignancy -associated heart failure and cardiomyopathy, a rather complex disease entity with high morbidity and mortality.
Highlights
Given the direct cardiomyocyte effects associated with chemotherapy, immunotherapy, other targeted antineoplastic agents, and radiotherapy, broad interest and attention has been given to cardiomyopathies and congestive heart failure (CHF) among the diverse cardiovascular pathologies identified in malignancy [8]
Similar to investigations of pathophysiologic mechanisms of Takotsubo cardiomyopathy (TCM) in the absence of malignancy, postulations on TCM pathways in cancer patients center on identifiable emotional and physical triggers, noticeably abundant in malignancy, and include the emotional and mental stress of diagnosis and living chronically with cancer, and the physical stress associated with the symptoms of the disease itself and effects of therapies [12]
We present a comprehensive summary of the modern understanding of heart failure and cardiomyopathy through the lens of malignancy, analysis of epidemiology, cardiotoxic profiles of chemotherapy, radiotherapy, immunotherapy, and other targeted antineoplastic therapies, cardiovascular outcomes and diagnostic management strategies in the setting of direct therapy associated cardiomyopathy and in TCM, and consider current and future perspectives on areas of investigation in cardio-oncology
Summary
Among the greatest stories in modern medicine, research and advancements in diagnostics and therapeutics is the field of oncology, with continuously evolving management and diagnostic modalities, and establishment of regional and national centers of excellence in clinical investigation and care for patients with cancer, the second leading cause of death in the United States [1].Highlighting the remarkable figures of increasing survival, reductions in mortality and annual incidence of cancer is a recent report with 2020 malignancy-associated morbidity and mortality projections by the American Cancer Society demonstrating the slowing of malignancy associated death and the notable gains in prevention and definitive treatment in cancer [2].While malignancy survival, mortality, incidence, and prevalence figures have prominently improved since the 1970s, cardiovascular disease mortality risk, both in active cancer patients and cancer survivors, is prominently increased [3]. With the identification of malignancy associated cardiovascular morbidity and mortality, and known cardiotoxic profiles of cancer related therapies including chemotherapy, targeted antineoplastic agents, and radiotherapy, the field of cardio-oncology has become one of
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